I have had chronic high blood pressure throughout my life – until I started hemodialysis. Prior to hemodialysis I took the maximum dose of 12 blood pressure medications daily. Today I take half of one drug – catapres (clonidine), and have fairly good control of my blood pressure. What’s the downside? Nearing the end of dialysis I have dangerously low blood pressure.

What causes this problem, and what can be done to help reduce it? As water is removed from your blood cells by hemodialysis your blood pressure drops. The more water you remove the more your blood pressure is lowered. Another way your blood pressure is reduced is eating within four to six hours of dialysis. And, everyone has lower blood pressure early in the day. Simply dialyzing at a later time in the day can increase your blood pressure.

Eating food too soon before dialysis reduces your blood pressure as your body moves blood from the rest of your body to your stomach to digest food and this lowers your blood pressure. I try to avoid eating a meal within four to six hours of dialysis.

I typically have problems during the last 30 minutes of dialysis. When dialysis is complete the NxStage unit rinses back your blood using .277 liters of saline. So the unit automatically adds the amount to the amount of water is takes off. Therein lies the problem, you are going that amount BELOW your dry weight nearing the end of treatment.

I have tried various methods for short term increase of blood pressure. They are all high in salt. But, a good side effect is that high salt also reduces the cramping in my legs that I also have when my blood pressure drops too low.

I have used chicken broth, the only downside is that you are drinking even more fluid that will have to be removed with dialysis. I mix one cube of chicken broth to half cup of water. This makes a very salty version of chicken broth, but it will raise your blood pressure and relatively quickly.

Others I use are dill pickles, but eating very many can be difficult, and my favorite – beef jerkey. I eat one when I start, then another after the first 30 minute machine check, and another 30 minutes later.

What if eating these items still don’t raise my blood pressure enough? The last option is to reduce the amount of fluid you are removing during dialysis, and/or adding saline.

So what’s the problem with low blood pressure? You can pass out, and can die from blood pressure that’s too low. Once you pass out, your dialysis partner only has a few seconds to give you saline to stop this process. My wife has had to do this for me twice during the first few months of dialyzing at home.

If I encounter low blood pressure more than once, it may mean that I need to raise my dry-weight. My nephrologist allows me to change my dry weight by up to .3 liter. I have not had to do this for more than a year, but it’s too dangerous to continually have low blood pressure while dialyzing.

Because I dialyze daily with the NxStage, I can easily take less off than I had planned on any given treatment, because I can just take off any excess the next day. This provides me with a lot of flexibility on the amount to remove on any given day.

The symptoms I encounter when starting to get low pressure are lightheadedness, sometimes my left calf starts cramping, which can become severe, and finally dizziness. It’s very important to know that at the first sign of any of these symptoms, check your blood pressure. By the time I feel lightheaded, I have about 30 seconds to react before I get in serious trouble. Because this usually happens to me during the last 30 minutes of treatment, I have become very good at recognizing and treating these symptoms.

From my completed flow sheets my ending blood pressures for the last few treatments were 92/59, 91/51, 102/52 and 79/45. On the last of these I had to both reduce the amount of water I was taking off and give myself saline.

Another important item I have discovered over the many times I have dialyzed at home is that my scale does not warn me when it’s battery is low, and it adds from .1L to .3L more to my weight. If I have low blood pressure during treatment for two days in a row, I change my scale batteries to correct this problem.

The good news is that over time, you will learn what causes low blood pressure, how it feels when you encounter it, and how easily it can be corrected before it becomes dangerous.

As I mentioned in my first post, I have been doing home hemo for four and a half years. Over that length over of time I have certainly had my share of saline and dialysate leaks.

Save yourself a lot of grief and tighten every connection each time you use a cartridge. 95% of the time the plastic connectors will be tightened at the factory, but when one comes loose during the prime process, you will leak saline in or on the NxStage unit. Of course, you can clear the error and clean up, but it’s a lot easier to just prevent this problem by re-tightening ALL the connections on the cartridge every time you use one.

The same is true for making a new batch of dialysate. The “chicken-foot” connection is connected to the dialysate SAK with a single connector, my experience has been that more times than not, this connection has not been tightened and must be before you continue making the SAK. If you don’t, you will eventually get a dialysate leak, which can be a lot of grief to correct.

I also tighten all three connectors on the end of the “chicken-foot”. Over the last few years I have never had one come loose, but over the last few months I have had two of them blown off during the completion of snap-and-tap, resulting in the loss of dialysate fluid.

Last, and most important, check that the caps on both of your needle lines are tight. I have even inserted a needle to find that there was no cap on the end, blood everywhere. As soon as I remove the needle sets from their packing I check that the cap on each line is tight.

One more tip – when you run from premixed dialysate bags, save the plastic screw-on caps from each of the bags you connect. They can come in handy in the future when you have a leak, and the cap you lost is rolling around on the floor.